How to birth your placenta after your baby has been born

After the baby is born, you would think that there is nothing left to do. Your contractions have stopped, you are cuddling your baby and a wonderful feeling of relief floods through you after all your hard work. But there is just one more thing left to happen: your placenta, or after-birth, has to come out.

Don’t worry, it’s about the size of your two hands cupped together and is soft and jelly-like, easy to pass. You won’t have painful contractions, or need to push hard.

Just like starting off in labour, your body knows what to do. As soon as your baby is born, the hormone oxytocin flows into your bloodstream and is carried to your uterus (womb). When you cuddle your baby skin-to-skin, this helps the oxytocin flow even better. You will lose track of time as you, and maybe your partner, admire your baby, seeing all their movements and expressions for the first time.

About five minutes after birth, you may feel a crampy pain, like a period pain. That is your placenta separating away from the wall of your uterus, and beginning to fall down into your vagina. You don’t need to do anything except make sure you are not lying down flat. Sitting up at about a 45 degree angle is best.

Stopping the bleeding

Shortly after, you will feel pressure or a slight pain down in your vagina or your bottom, a bit like feeling you have to go to the toilet. You may feel some blood trickling or gushing out, just for a moment. Usually, if you part your legs and give a little push, the placenta will fall out and the midwife will sort the rest out (Begley et al 2012).

Your body knows what to do to stop the bleeding. For example, a few minutes after you cut your finger, the bleeding slows down and then stops because your body has built up a fine mesh of fibres criss-crossing the wound in which little blood clots get caught, which develops into a bigger blood clot that eventually forms a scab.

The same thing happens inside your uterus: a thin web of fibres forms and slows down and then stops the bleeding. Your uterus also contracts very strongly. You will be able to feel the top of it as hard and round, just at the level of your navel (belly button) in your soft tummy.

Assisted third stage of labour

Sometimes, the midwife or doctor will suggest that you have an injection to speed up the after-birth coming or to reduce how much blood you lose. This means that the cord may be clamped and cut a little earlier, and the midwife will need to press gently but firmly on your tummy and pull on the umbilical cord to deliver the placenta.

If you are at low-risk of bleeding, it is uncertain whether having this injection does decrease postpartum haemorrhage (losing more than 1 litre of blood) or not. It is also uncertain whether or not having this injection decreases the risk of anaemia (having a low blood count after birth) (Begley et al 2019). There is little or no difference in the length of time it takes for the placenta to come.

Advantages

Having the injection has potential advantages:

• It may reduce the total amount of blood you lose by about 78mls.
• It may reduce the chance that you’ll need a blood transfusion.
• It can also reduce the chance that you’ll bleed more than 500mls (the amount of a routine blood donation).
• It may increase your haemoglobin levels after birth.

Disadvantages

However, there are possible downsides to having the injection:

• It may increase your blood pressure after birth.
• You may be more likely to need pain-relieving medicine soon after birth.
• You may have more after-pains.
• You may be more likely to have bleeding after birth that requires you to return to hospital.
• It may also reduce the baby’s birth weight between the time of birth and when it is measured (because of the 70mls of baby’s blood that stays in the placenta when the cord is clamped early).

If you had an oxytocic infusion in labour, or if you are at high risk of bleeding just after birth, your midwife or doctor may suggest to you that having the injection, and having this ‘third stage’ of labour managed actively by them, might be the best course of action.

Discuss with your midwife in pregnancy, and again in early labour. Talk to them about what you would like to do during this stage of labour, so that you are prepared.